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Sex-specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: An individual patient data meta-analysis

du Fay de Lavallaz, Jeanne and Badertscher, Patrick and Kobori, Atsushi and Kuck, Karl-Heinz and Brugada, Josep and Boveda, Serge and Providência, Rui and Khoueiry, Ziad and Luik, Armin and Squara, Fabien and Kosmidou, Ioanna and Davtyan, Karapet V. and Elvan, Arif and Perez-Castellano, Nicasio and Hunter, Ross J. and Schilling, Richard and Knecht, Sven and Kojodjojo, Pipin and Wasserlauf, Jeremiah and Oral, Hakan and Matta, Mario and Jain, Sandeep and Anselmino, Matteo and Kühne, Michael. (2020) Sex-specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: An individual patient data meta-analysis. Heart Rhythm, 17 (8). pp. 1232-1240.

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Abstract

Atrial fibrillation (AF) is a growing health burden, and pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represents an attractive therapeutic option. Sex-specific differences in the epidemiology, pathophysiology, and clinical presentation of AF and PVI are recognized.; We aimed at comparing the efficacy, safety, and procedural characteristics of CB and RF in women and men undergoing a first PVI procedure.; We searched for randomized controlled trials and prospective observational studies comparing CB and RF ablation with at least 1 year of follow-up. After merging individual patient data from 18 data sets, we investigated the sex-specific (procedure failure defined as recurrence of atrial arrhythmia, reablation, and reinitiation of antiarrhythmic medication), safety (periprocedural complications), and procedural characteristics of CB vs RF using Kaplan-Meier and multilevel models.; From the 18 studies, 4840 men and 1979 women were analyzed. An analysis stratified by sex correcting for several covariates showed a better efficacy of CB in men (hazard ratio for recurrence 0.88; 95% confidence interval 0.78-0.98, P = .02) but not in women (hazard ratio 0.98; 95% confidence interval 0.83-1.16; P = .82). For women and men, the energy source had no influence on the occurrence of at least 1 complication. For both sexes, the procedure time was significantly shorter with CB (-22.5 minutes for women and -27.1 minutes for men).; CB is associated with less long-term failures in men. A better understanding of AF-causal sex-specific mechanisms and refinements in CB technologies could lead to higher success rates in women.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:du Fay de Lavallaz, Jeanne and Badertscher, Patrick and Kühne, Michael
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Elsevier
ISSN:1547-5271
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
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Last Modified:15 Mar 2022 13:22
Deposited On:15 Mar 2022 13:22

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